Provider Demographics
NPI:1487033262
Name:BROWN, JENALEE KAY (MS OTR/L)
Entity type:Individual
Prefix:
First Name:JENALEE
Middle Name:KAY
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:JENALEE
Other - Middle Name:KAY
Other - Last Name:CHRISTOPHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:901 CALEDONIA ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54603-2616
Mailing Address - Country:US
Mailing Address - Phone:920-539-2268
Mailing Address - Fax:
Practice Address - Street 1:901 CALEDONIA ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-2616
Practice Address - Country:US
Practice Address - Phone:608-785-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104880225X00000X
WI5683-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5683-26OtherWISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES
MN104880OtherMINNESOTA DEPARTMENT OF HEALTH